Dr O has two items in The Obstetrician & Gynaecologist, which confirm
my belief that oestrogen to psychiatrists is like garlic to Dracula. It
is equally illogical. It is unbelievable that for an article on Postnatal
Depression, oestrogen has a brief last paragraph footnote informing that oestrogen
can act like an antidepressant by the effect upon the dopaminergic and serontonergic
receptors. Indeed it does and for this and other logical reasons as
well as scientific and clinical evidence that should be used in those conditions
of depression in women related to changes in oestrogen levels. These
will include premenstrual depression, postnatal depression and peri-menopausal
depression. These have all been shown in double blind trials to be responsive,
greater than placebo to transdermal oestrogens, yet the original Lancet paper
showing the beneficial effect of this on postnatal depression is not featured
in the text or references although the co-authors were psychiatrists, Dr Alan
Gregoire and the distinguished expert on postnatal depression the late professor
Chani Kumar .It is bad enough that these studies have not been repeated by
those responsible for the care of depression i.e. psychiatrists but
the refusal to reference and discuss such a paper is intolerable.

There is good evidence that postnatal depression, premenstrual depression
and peri-menopausal depression confirm the same vulnerable women and it is
a commonplace experience that depressed 45-year-old women will say that they
were last well when they were last pregnant 10+ years ago. They then
developed postnatal depression and were put on antidepressants. When
the periods returned they developed a cyclical depression and towards the
menopause the depression became less cyclical so they no longer even have
7 good days a week but every day as the depression is now continuous.

The tragedy is that these women were given antidepressants of doubtful value
and certain side effects at the time of their postnatal depression. Over
the years they then suffer ineffective multi-drug therapy frequently with
ECT (particularly in the private sector). At this stage it is difficult for
women to come off these powerful drugs, which they probably shouldn’t
have had in the first place. It is true that women with postnatal depression
and other types of hormone responsive depression do not have different hormone
levels than those without depression. Nobody ever said that they did. It
is simply a response to changes of oestrogen and no doubt progesterone in
women, who, for some reason, are biochemically vulnerable to these hormonal
changes.

The diagnosis of reproductive depression is not based upon blood tests but
on the history relating the current depression to the history of being in
good mood during pregnancy followed by postnatal depression. There is
also a history of previous premenstrual depression and perhaps the history
of menstrual headaches is a further clue to the cyclical and endocrinological
basis for this condition.

I am very pleased that Dr. O reports that the article most read by psychiatrists
last month was ‘Oestrogen relieves psychotic symptoms in women with
schizophrenia’. This has of course been known for more than ten
years. I am not reassured that psychiatrists have an interest in this
but I would be more impressed if they actually used oestrogens for such an
indication. But they do not. Similarly psychiatrists must learn how to use
oestrogens for certain sorts of depression in women as an effective safe alternative
to their usual armamentarium. It would surprise them to discover how frequently “bipolar
depression” disappears once the cyclical mood changes of PMS are ablated
by transdermal estrogens. In reality the psychiatrist’s dismissal of
the evidence and refusal to study the issue further is merely a turf war resulting
from their inadequate knowledge of the basic practicalities of hormone therapy.